To ask the Minister of Health (i) what assessment has been made of progress in reducing stillbirth and neonatal mortality rates since 2010; and (ii) how these outcomes compare with other UK regions.

Along with the other UK administrations, the Department funds the Health Care Quality Improvement Partnership (HQIP) to commission the Clinical Outcome Review Programmes (CORP), which includes the Maternal, Newborn and Infant Programme provided by MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK). The aim of the programme is to provide robust information to support the delivery of safe, equitable, high quality, patient-centred maternal, newborn and infant health services. MBRRACE-UK achieves this by:

Surveillance of all maternal deaths

Confidential enquiries into maternal deaths during and up to one year after the end of the pregnancy

Confidential enquiries into cases of serious maternal morbidity on a rolling basis

Surveillance of perinatal deaths including late fetal losses (22-23 weeks gestation), stillbirths and neonatal deaths

Confidential enquiries into stillbirths, infant deaths and cases of serious infant morbidity on a rolling basis

The most recent MBRRACE-UK report is published at this link https://timms.le.ac.uk/mbrrace-uk-perinatal-mortality/surveillance/#perinatal-mortality-in-the-uk

Figure 1 in the report shows the Stillbirth, neonatal and extended perinatal mortality rates for the UK and by country of residence, 2013 to 2023.

Extended perinatal mortality rates decreased across the UK in 2023 (UK extended perinatal mortality rate: 4.84 per 1,000 total births). The long-term reduction in perinatal mortality is driven largely by a reduction in stillbirths.

Compared with rates in 2022, stillbirth rates per 1,000 total births in 2023 were lower across the UK: 3.22 (UK); 3.27 (England); 2.95 (Scotland); 3.32 (Wales); and 2.51 (Northern Ireland).

There were decreases in the neonatal mortality rate per 1,000 live births in England, Wales and Northern Ireland compared with 2022: 1.63 (UK); 1.62 (England); 1.61 (Scotland); 1.79 (Wales); and 1.66 (Northern Ireland).

As would be expected, the highest numbers of deaths are associated with babies born in the regional maternity unit in Belfast Trust. Like elsewhere in the UK, in Northern Ireland the mothers of the smallest and sickest babies are normally transferred to the regional neonatal intensive care unit at the Royal Jubilee Maternity Hospital (RJMH) Belfast. On most occasions the transfer will take place antenatally with the result that baby is both born and dies in RJMH. The largest burden of neonatal mortality is therefore associated with tertiary units.

Implementation of guidance on assessment of signs of life before 24 weeks is continuing to ensure that there is consistency in reporting of neonatal deaths.

Training and funding (£25K recurrent funding per HSC Trust in Northern Ireland) has been provided to support Trusts to develop skills and embed processes for timely multidisciplinary review of all perinatal deaths using a standardised tool (PMRT). A process being established to facilitate PMRT reporting at regional level via the Public Health Agency (PHA).

An audit (using confidential enquiry approach and external review) has been coordinated by the PHA to support quality assurance of perinatal mortality review.

In 2021, each Trust received funding allocation for a Band 7 Risk Midwife through the Delivering Care process to support perinatal mortality surveillance and review processes.

Parents’ decisions around post-mortem continue to be supported. A formal evaluation of paediatric and perinatal pathology service with Alder Hey is underway including externally commissioned work to seek views from families.

A Saving Babies’ Lives group has been established. Two sub-groups have been formed specifically to look at fetal growth and reducing pre-term birth. Surveillance of pre-term birth is included in the work plan.

A review of recommendations contained in a series of MBRRACE reports published from 2017 has been undertaken. A workshop took place in December 2023 that considered the outcome of stakeholder engagement and the key themes of non-compliant recommendations. A composite database and action plan has been developed to include NICE, MBRRACE-UK, RQIA and other CMO and CNO endorsed recommendations.

The RQIA report was published on 31 May 2023 and accepted in principle by CMO. Following an audit of compliance levels across a range of recommendations a letter was issued to Trusts to clarify that they should implement the RQIA's recommendations without delay. Implementation of these recommendations is being monitored by the new Women’s and Children’s Planning Team.

Serios Adverse Incidents have been reviewed by a weekly incident review group for any urgent action and no major safety issues have been highlighted. This area of work is also being considered as part of Safety and Governance Processes.

The need for a regional maternity and newborn partnership has been identified.

Abortion services are now available in all five hospital Trusts which enable most of the demand to be met locally. Medical abortion is available in all circumstances as set out in the 2020 Regulations. Demand shows that a high percentage of all abortions undertaken in NI are managed in the early medical abortion and vacuum aspiration service (below 12 weeks) available in all 5 Trusts. Surgical abortion is available for up to 20 weeks gestation and work is ongoing to expand this service to pregnancies up to 23+6 days in late September. Women requiring access to this service can continue to access free abortion care in Great Britain via a service level agreement managed by the South Eastern Health and Social Care Trust.